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Jack B. Williams, M.D.
JAMA. 1959;170(3):361. doi:10.1001/jama.1959.03010030105030.
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To the Editor:—  A comment is in order regarding the article entitled "Respirator Tracheotomy Tube" in The Journal, March 21, 1959, page 136. The idea of devising ways to decrease leaks in the system is a good one and is at times highly desirable in respirator patients. Whether a tight fit is absolutely necessary depends on one's philosophy regarding the use of respirators and on the type of respirator unit being used.A definite danger exists in the use of this type of tube-and-cuff arrangement. The basic idea is sound and has been used by many anesthetists to administer anesthetics and to ventilate patients on the wards, but unless the inflatable cuff is cemented to the metal tracheotomy tube there is the constant hazard that the cuff will slip off and obstruct the patient's airway. Unless this situation is diagnosed quickly and the cuff withdrawn the obstruction may be sufficient


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